Psychosurgery


Science has a lot of credibility in our society. Science is often presented as a rational, self-correcting process in which peer review and open critical discussion provide powerful safeguards against gross error. Episodes such as the Piltdown Man, a famous fraudulent human ancestor, are dismissed as aberrations of a few individuals. There is a case in living memory where the full weight of the scientific establishment endorsed and supported an idea that ruined tens of thousands of lives in the United States and Europe.

Psychosurgery was the belief that scientists and doctors could treat and even cure mental illness through surgical operations on the brain, specifically the frontal and pre-frontal lobotomy. In a lobotomy, surgeons cut or drill holes in the front of the skull and remove or destroy tissue in the frontal lobes. This is the cerebral cortex where most current evidence indicates the higher cognitive and reasoning capabilities of humans are localized. The consequences of brain damage in these areas are severe. Between 1935 and 1960 scientists and surgeons performed over 30,000 psychosurgical procedures in the United States. Rosemary Kennedy, the older sister of President Kennedy, was lobotomized during the 1940's.

Psychosurgery was not the work of cranks, outsiders to the medical establishment, or faith healers. Antonio Egas Moniz was a Portugese neurologist who had developed a technique for cerebral angiography, considered a major contribution to his field. Inspired by operations on the brains of monkeys, Dr. Moniz began to operate on humans, starting on Nov. 12, 1935. He reported great results and his work was embraced worldwide. He was awarded the Nobel Prize in Medicine in 1949, the highest and most prestigous scientific award in the world.

Moniz directed about 100 lobotomies. Then, he was shot in the spine and crippled by a former patient. But other scientists throughout the world took up his work.

In the United States, Walter Freeman and James Watts, a neurologist and neurosurgeon at George Washington University, embraced Dr. Moniz's ideas. Freeman and Watts performed the first operation in the United States on September 14, 1936, less than a year after Moniz's first operation. They wrote a textbook in 1942. By 1950, the high point of the psychosurgery movement, they had performed over 1000 operations on human patients. Their book was Psychosurgery in the Treatment of Mental Disorders and Intractable Pain, a thick tome with tables, research results, and detailed instructions on how to perform the surgery. They were leading experts in the United States. They recommended the prefrontal lobotomy for everything from schizophrenia to depression to unemployment.

Even in 1950, some dissenters criticized psychosurgery. Psychosurgery has fallen completely out of favor today. Psychosurgery has been thoroughly discredited and the entire episode is a scandal in medical history. We now know enough about the brain to know how destructive and unpredictable the results of the operations were. Many of the victims of psychosurgery were turned into vegetables.

Since the 1950's, psychosurgery has been replaced by purported "antipsychotic" drugs such as Halperidol and Thorazine for the treatment of schizophrenia, the most commonly diagnosed mental illness in the United States. These drugs were developed as animal tranquilizers. Their effect on "normal" people is to sedate or knock them out. Prolonged use of these drugs can result in tardive diskinesia, a shaking illness similar to Parkinson's Disease. There is considerable research and clinical experience linking schizophrenia to an excess of the neurotransmitter dopamine in the brain. The antipsychotic drugs seem to reduce the concentration of dopamine in the brain and to alleviate the symptoms of schizophrenia.

Recent years have seen a proliferation of drugs known as Selective Serotonin Reuptake Inhibitors (SSRI) such as Prozac for treatment of depression. Serotonin is one of the key neurotransmitters in the brain. Its exact functioning remains a great mystery. Both aspirin and LSD are chemical relatives of Serotonin.

Psychosurgery shows that the scientific process can fail utterly. Psychosurgery occurred in open, democratic societies, not in Nazi Germany or Stalin's Russia. Psychosurgery lasted for at least twenty-five years. Destructive and false ideas can become accepted scientific truth despite peer review and other mechanisms of the scientific system. Could it happen again? Is it already happening?


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© 1997 by John F. McGowan, Ph.D.